Mandatory Vaccinations in the UnitedStates of America            In today’s society, shaping ourchildren’s futures is not only a mental aspect but  also a physical one. In the past, it has beenwidely accepted in America that vaccinations promote the well being of thepopulation and prevent disease outbreaks from occurring. Currently, however, agrowing hesitation and skepticism regarding childhood vaccines is causing areappearance of vaccine preventable illnesses (Hendrix et al.

) The goal of this paper is toinvestigate mandatory vaccination and the many factors associated with theparental decision to abide by or object to these requirements, and present the ethicalargument for both perspectives on compulsory immunization in the United Statesof America.To achieve this goal, this paper isdivided into four sections. First, I will explain the history behind vaccinelaws in the U.S. and discuss the impact it has on today’s society. Then, I willdiscuss the factors that have an influence on families’ choices in regards tovaccinating their children. Lastly, I will provide the debate in favor and notin favor of mandatory immunizations and conclude with the advocacy for vaccineregulations in America.

History of Vaccination LawsThe first U.S. law for immunizations appeared in United States in the 19thcentury when smallpox outbreaks were prevalent. This is when vaccinationsbecame widely accepted by the population as a reliable health intervention forpreventing the spread of disease (Omer et al.) Because vaccinations wereextremely successful at this point in time, many states started to enforce lawsregarding mandates to receive them and in turn caused a decline inadministration rates (Omer et al.).

In 1905, the U.S. Supreme Court approvedthe rights of states to enact their own vaccination laws, and seventeen yearslater mandatory school immunization requirements were ruled constitutional(Omer et al.). In the 1960s and 70s, measles was at an all time high and ultimatelygave the big push into the modern era of immunization laws. By 1980, schoolimmunization requirements were applied by all 50 states (Omeret al.).

There is no nationallegislation concerning vaccinations but state laws require children to bevaccinated in order to be eligible for enrollment in public and private school(Welborn). Most educational institutions follow the Centers for Disease Controland Prevention schedule of immunizations as a guide for administering vaccines atcertain ages (Welborn). Since the U.S.

has implemented school vaccinerequirements, there has been a significant decline in vaccine preventablediseases within the school-aged population. Specifically, Smallpox has beeneradicated and Polio has disappeared from the Western Hemisphere, while Measleshas been on a steady comedown (Hinman et al.).

Day cares and academicestablishments are and will continue to be key components of the Americanimmunization system (Orenstein and Hinman). Factors Influencing Vaccination Choice            The factors involved in familial decision-makingwhether to immunize their children include school enrollment, parentalknowledge and beliefs, community awareness, and accessibility to healthcare.The main aspect that families consider when deciding to vaccinate is enrollmentin school. There are different requirements for each state regarding theimmunizations needed to attend and the exemption reasons accepted for a childnot to be vaccinated. In all 50 states, medical exemptions are allowed whichincludes but is not limited to allergies, congenital conditions where vaccinesare contraindicated, and impairment of the child’s immune system (“VaccinationExemptions”). In 48 states, religious exemptions, conflicts betweenimmunization and religion that is not based upon personal or scientificreasoning, is authorized (“Vaccination Exemptions”). Only 21 states grantphilosophical/personal exemptions, which are reasons the family does not wantthe child to be vaccinated and they personally object to one or morevaccinations (Orenstein and Hinman).

These three exemptions exist so thatfamilies who do not wish to vaccinate their children can still attend school. Ifthe family does not live in a state where personal exemptions are accepted andthere is no religious or medical reason to not vaccinate, the child must beimmunized. Parental knowledge and beliefs include concerns about vaccine safety andefficacy, evaluation of the risks and severity of a disease, and trust in thehealthcare system (Salmon et al.). These aspects help families weigh thebenefits and risks associated with immunizations. A family is more likely toforgo vaccinating their child if they are not up to date on recommendations andthey believe vaccines will cause more harm than good (Omer et al.

). A commonperception today is that, “…children receive too many vaccines,” (Omer et al.).Another one of the numerous misconceptions of vaccinations is that Autismoccurs from immunizations, yet it is not supported by scientific evidence.

Thishad led to the refusal of parents around the U.S. to not vaccinate (Omer et al.

).Families also assess how dangerous diseases are and whether or not they feelthat their child is at risk of contracting them. Low perceived disease severityand risk for disease is associated with noncompliance to vaccination, while anincreased perceived disease severity and fear of catching these diseasesinfluence families to obtain immunizations (Salmon et al.). Trust in thehealthcare system and government also impact the decision making process ofvaccination choices in households. Conspiracy theories and the monetary aspectof vaccinations play a negative role in promoting them (Salmon et al.

). Community awareness about the effect immunizations have on public healthand access to healthcare are factors that are not often discussed but havesignificant importance on families’ vaccination decisions. Children who havethe ability to get vaccinated protect those who cannot, such as children withcompromised immune systems and young infants (Hendrix et al.). Communityimmunity is a term that is used to describe an area where most of the membersof that neighborhood are protected against a disease because a certain portionof the population there is immunized, therefore preventing the spread to peoplewho cannot get vaccinated (“Community Immunity (“Herd Immunity”)”).

It isbecoming more common for members to not get immunized because they believeeveryone else is vaccinated so they do not have to. They are unaware of howtheir choices affect others in the community and are increasing the likelihoodfor an outbreak to occur that could potentially cause multiple deaths (Hendrixet al.). Those who are informed about community immunity are more likely to gettheir children vaccinated.

Access to healthcare also plays a large role in familialdecision-making. When a family has “access barriers” such as lack oftransportation or the inability to afford care, they have a harder timereceiving vaccines for their children and are less likely to be vaccinated(Hendrix et al.). Others who do not have these barriers are able to receivevaccines without difficulty and increase the likelihood to partake.

The “accessbarriers” are another pertinent factor on why community immunity is importantfor families to be knowledgeable on. After analyzing the factors that determinea family’s decision to vaccinate their children, we arrive at the ethicaldilemma whether it is morally right for vaccinations to be mandatory forchildren in the United States. Ethical Arguments            Mandatory vaccination requirementsshould not be effective in America because it is not only violating of theethical principles of autonomy and justice, but also adhering to paternalism. Autonomyis having the right to decide what will happen to oneself (Guido 35). This isapplicable with children because parents are the decision-makers for them atthis point. Informed consent is a direct relation to this principle, and bymaking immunizations mandatory this right is being taken away because they donot wish to have vaccinations and are not giving consent to receive this care.

Alsoincluded within autonomy is independence, which is “…being able to act, reason,and decide for oneself,” and agency, “…the power to be in command andresponsible for one’s actions,” (Guido 36). Families’ independence and agencyis taken against their will and they are not able make decisions and takeresponsibility for those choices because the entirety of autonomy is beingremoved from them. Our country is based upon the concept of freedom, exceptthis is a direct violation of families’ freedom. The ethical principle ofjustice means to give each person what they deserve and being treated fairlyand equally (Guido 38). Specifically social justice can be applied becauserequiring this health intervention puts the burden of accessing healthcare onfamilies where access may be limited or not feasible. This would be consideredunfair and not equitable. Paternalism is making the final decision for others andis viewed as a negative ethical principle (Guido 37). Mandatory vaccination isa very clear example of this because it allows the removal of thedecision-making process from families and in turn violates their freedom (Guido37).

Healthcare providers can also contribute to families’ decisions byproviding them with alternatives other than vaccines such as enhanced hygieneto reduce mortality and morbidity (Van Delden et al.). This would includebetter sanitation but the specific germs that cause disease still exist andwill continue to make people ill (“Vaccines are Effective”).

Parents have theright not to vaccinate their children in any of the 50 states if they have amedical condition where immunization is not safe, but if they live in a statewhere personal exemptions are not available to them then mandatory vaccinationrequirements is violating autonomy, justice, and invoking paternalism.             Compulsion immunization should be enabledin the United States because it is promoting the ethical principles ofbeneficence and nonmaleficence. Beneficence is the act of promoting good and isthe fundamental principle of health care ethics (Guido 36). By having childrenimmunized, families are helping to prevent disease outbreaks from occurring andprotecting the community.

This is a critical principle to community immunitybecause not everyone can receive vaccines but the ones who do are promoting thehealth of others. This coincides with the ethical principle of nonmaleficence,which is doing no harm and including preventing the suffering of others (Guido36). The decision to vaccinate contributes to eradicating disease and reducingthe risk of spreading diseases to others and decreases the risk of inflictingsuffering upon the citizens around them. Immunizations are extremely important in the school-aged populationbecause they are considered super spreaders.  This is because they are around large amountsof kids in close proximity and this is a probable environment for diseases tobreak out and infect multiple people around the community.

By vaccinatingchildren, we can reduce the spread of diseases in an area by almost 75 percentand prevent the possibility of outbreaks from occurring.  Mandatory vaccination is how the U.S. protectsits own people and should be considered as an advantage. Advocating for Mandatory Vaccination            Compulsory immunizationrequirements should be a mainstay in the American society because they areimmensely beneficial in hindering vaccine-preventable diseases from occurring,save families money, allow children to receive education, and are a safe andeffective way to protect the future generations. To this day, smallpox andpolio are no longer issues in our population because vaccines have made thispossible.

The measles vaccine has been very successful in regulating thisdisease that used to cause a lot of mortality (Omer et al.). Recently,outbreaks of measles have started to reappear because people are deciding tonot vaccinate their children, which then causes it to spread quickly within thepopulation that is not vaccinated. If this trend stays consistent for long,more vaccine-preventable diseases are going to start popping up in the UnitedStates population and morbidity and mortality rates will start to rise as theydid before vaccination became possible. Also, when people come in and out ofthe U.S.

who are from different countries where many vaccine-preventablediseases are located, it puts everyone around them at risk for contractingthose diseases. Therefore, it is better for children to be vaccinated so thatthere is no hazard in being in contact with these children coming from othercountries. Families will save money by having their children immunized because theywill not pick up these diseases, therefore, the parents will not have to takeon extra medical bills or take time off of work to care for a sick child. Also,if a child comes down with a vaccine-preventable disease they can be excludedfrom school or day care. This has a negative impact on a child’s education andis something that families should want to avoid.

Lastly, families who immunize their children are taking the preventativesteps of protecting the future generations from these illnesses and couldpossibly even eradicate some of the vaccine-preventable diseases that we dealwith today. All vaccines that are given in the U.S. have to be approved by theFood and Drug Administration before it can be used. A large amount of testingis done, such as clinical trails, and is only approved if it is effective andsafe to be used by the population (“Vaccines are Effective”).

Mandatoryvaccination should be upheld within America so that we can all live longer andhealthier lives. Conclusion            The United States of America reliesheavily on compulsory immunization to keep the population safe from dangerousvaccine-preventable diseases because it is the most efficient public healthintervention that we have. As investigated, there are multiple factors thatplay into the decision-making process for families to get their childrenvaccinated and there are reasonable ethical arguments from both sides. Overall,the controversy of this topic is intense, but the benefits of immunizationoutweigh the negatives and the U.S. should continue to implement theserequirements for the greater good of our country.



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